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Kusserow’s Corner: Physician Arrangements Remain the Number One Enforcement...

From the very beginning of the Medicare and Medicaid programs, Congress was concerned about the corrupt influence of money in medical decision-making.  Simply put, it did not want patients bought and...

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Kusserow’s Corner: Ongoing Monitoring and Auditing of Physician Arrangements

In all its compliance guidance, the OIG stresses the importance of ongoing monitoring and auditing of high-risk areas. Physician arrangements rank as the number one compliance high risk area; however...

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Kusserow’s Corner: The Stark Law Remains an Enforcement Priority

The Physician Self-Referral Law, commonly referred to as the Stark Law, prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid to entities...

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Kusserow’s Corner: $12 Million Visiting Physician Practice Fraud Scheme...

The federal government has been aggressively investigating home health billing including in-home physician visits and home health agency and other related billings to Medicare. On October 29, 2013, the...

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Kusserow’s Corner: New Stark Enforcement Sends Shockwaves through Hospitals

The Department of Justice (DOJ) is increasing its enforcement efforts focused on questionable physician arrangements. Qui tam “whistleblowers” are leading them to new False Claims Act (FCA) cases...

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Kusserow on Compliance: Advice on selecting an Independent Review...

The HHS Office of Inspector General (OIG) has over 300 active Corporate Integrity Agreements (CIAs) in force. They result from a settlement of a civil false claims case with the Department of Justice...

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Kusserow on Compliance: OIG new fraud alert: physician compensation arrangements

The Office of the Inspector General (OIG) has issued a new Fraud Alert relating to physician compensation arrangements. For many years now, both the OIG and the Department of Justice (DOJ) have...

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Kusserow on Compliance: Breaking News: Decade long saga of the Tuomey Case...

On July 2, 2015, the U.S. Court of Appeals for the 4th Circuit published a 67-page decision in the decade-long Tuomey Healthcare System case. The original case arose from a qui tam (whistleblower suit)...

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Kusserow on Compliance: Lessons learned from the Tuomey case

Now that the dust is settling on the decision in the Tuomey case, it is worth reflecting on what can be learned from it. It is rare for a hospital system to go to trial based on government charges...

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Kusserow on Compliance: Physicians personally face increased enforcement...

In a previous blog post, I reported on the new Office of Inspector General (OIG) fraud alert warning physicians that they could face liability under the Anti-Kickback Statute (AKS) (42 U.S.C. §...

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Kusserow on Compliance: CMS moves to ease Stark rules for providers and for CMS

In the face of the landmark Tuomey case decisions that have added teeth to the enforcement of the Stark laws, CMS has learned what providers have known for years: vagueness in the law requires more...

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Kusserow on Compliance: Overlap between physician-owned hospitals and...

The HHS Office of Inspector General (OIG) issued a new report about the limited available information to identify physicians who have concurrent ownership interests in physician owned distributors...

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Kusserow on Compliance: Oncology remains high federal enforcement priority

Oncology continues to be a high enforcement priority for the DOJ, OIG, FBI, and CMS.  The latest fraud investigation by the DOJ involves CCS Oncology, large and prominent providers of cancer care. The...

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Kusserow on Compliance: Changes in the Stark Law

Over the years, the Stark law has evolved considerably from regulatory requirements to use by the DOJ in enforcement of the False Claims Act. Unlike the Anti-Kickback Statute, which is enforced by the...

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Kusserow on Compliance: OIG cases involving sanctioned parties and tips to...

Compliance Officers must screen employees against the List of Excluded Individuals and Entities (LEIE). This is stressed in all of the OIG’s compliance guidance documents. CMS makes it a condition of...

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Kusserow on Compliance: Stark law to undergo interagency review

The CMS Administrator announced plans to convene an inter-agency group to focus on how to minimize the regulatory barriers created by Stark law, which was established in 1989 and underwent expansion in...

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Kusserow on Compliance: Huge fraud schemes involving telemedicine and DME

– Charges against two dozen people involving over $1.2 billion  – Administrative Action against 130 DMEs submitting $1.7 Billion in claims The DOJ announced charges against 24 defendants—including the...

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Kusserow on Compliance: CMS issues final rule on affiliation disclosure...

CMS issued a final rule on September 10 that sets forth requirements mandating providers and suppliers who submit an application for enrollment or revalidation for Medicare, Medicaid, or the Children’s...

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Kusserow on Compliance: Medicare overpaying for graduate medical education (GME)

A study published in the Journal of the American Medical Association (JAMA) Internal Medicine raises questions about overpayments by Medicare for graduate medical education (GME) to train residents. By...

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